Atrial fibrillation — an irregular heartbeat that occurs when the upper chambers of the heart are out of sync with the lower chambers — affects 5.5 million people in the U.S. Among those millions is John Gibbons of Altoona. For Gibbons, atrial fibrillation (AF) meant difficulty breathing and chest pains. His symptoms—getting winded walking short distances—began about 3 years ago and were misdiagnosed as asthma until June, when an echocardiogram revealed his true condition. In September, to correct his AF, Mr. Gibbons had a Cox maze procedure performed by McGowan Institute for Regenerative Medicine faculty member Kenton Zehr, MD, Chief of Cardiac Surgery at the Heart, Lung, and Esophageal Surgery Institute at the University of Pittsburgh Medical Center.
‘‘We cut it up and sew it back together,’’ Zehr said. ‘‘It’s a specific set of cuts and freezes that stops the non-organized rhythm.’’
Recovery is similar to most open-heart procedures — a week in the hospital and a month of feeling ‘‘pretty creaky,’’ Zehr said. But after recovery, most patients can return to their normal activities.
‘‘The whole idea is to improve their quality of life,’’ he said.
Mr. Gibbons said that’s been the case for him. The surgery has allowed Gibbons to return to his favorite pastimes — without getting winded.
“I can do the things I love to do, like go to sporting events,’’ Gibbons said. ‘‘I can actually go to Mansion Park and watch games. And I enjoy playing basketball.’’
Besides allowing him to return to his hobbies, Gibbons said the surgery has also changed his life outlook.
‘‘I have a stronger faith since all this happened,’’ he said. ‘‘Everything in life has a different perspective.’’
The Cox maze procedure is a type of heart surgery for AF. James Cox, MD, and associates developed the "maze" or "Cox maze" procedure, an "open-heart" cardiac surgery procedure intended to eliminate AF, and performed the first one in 1987. “Maze” refers to the series of incisions arranged in a maze-like pattern in the atria. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This required an extensive series of endocardial (from the inside of the heart) incisions through both atria, a median sternotomy (vertical incision through the breastbone), and cardiopulmonary bypass (heart-lung machine; extracorporeal circulation). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard” for effective surgical cure of AF. The Cox maze III is sometimes referred to as the “Traditional maze”, the “cut and sew maze”, or simply the "maze".
Dr. Zehr is also a Professor of Surgery at the University of Pittsburgh.
Illustration: University of Pittsburgh Medical Center.
Altoona Mirror (02/18/08)
Heart, Lung, and Esophageal Surgery Institute at UPMC
Cox Maze Procedure, Wikipedia